Friday, March 12, 2010
As the conflict over health care reform rages in Washington, a far more important revolution is gently taking shape here in California.
California Universal Healthcare Act, Senate Bill 810 provides for the most radical, sweeping health care overhaul ever attempted in any state or by the federal government. And it's no pie in the sky it has twice passed both the state Senate and Assembly and only a governor's veto has prevented it from becoming law. Should Governor Arnold Schwarzenegger's replacement be a Democrat, California's health care landscape might be forever changed.
Major provisions of SB 810 comprise:
- All private California health care insurance institutions Blue Cross, Blue Shield, Medicaid, Medicare and others will be replaced by the California Healthcare Agency, a state-run single payer plan which collects all medical premiums and pays all providers. Non-medical administrative costs cannot exceed 10 percent of revenue for five years and 5 percent after that. (Private insurers spend up to 30 percent on administrative costs.) All Californians would be qualified for a fixed benefit package free, at least initially, from co-pays and deductibles.
- All income will be raised by existing government program funds plus premiums paid to the program, replacing commercial premiums. Premium amounts probably shared by employers and employees would be set by a premium subcommittee, and by law revenue must cover the cost of providing care. Choice of doctor and hospital is preserved and both remain in nongovernmental hands.
- All hospitals and doctors will be compensated through negotiations with the payments board committee of the health plan made up of "experts in health care finance and insurance" and others. Should negotiations fail, "the Payments Board shall launch reimbursement rates which shall be binding".
The payments are collected and distributed through regional payment centers, similar to what Medicare uses, and like Medicare, a single payer plan allows for private choice of physicians, hospitals and all medical providers. The difference between Medicare now and a single payer plan would be that everyone would be in the risk pool, young and old, sick and well, spreading the risk, so the plan would be cheaper. Also, insurance companies would no longer be allowed to be for-profit, which would save at least 20 percent of our health care dollars that go now for big business administration costs and profit.
Wednesday, March 10, 2010
As the nation struggles with the urgent challenges of checking all Americans have access to quality, affordable care, health insurance plans are building ahead with proposal to progress health care quality through reporting and payment reforms that support value, encourage ongoing improvement, and advance high-quality health care.To acquire an improved sense of the extent and multiplicity of health plan programs and proposals aiming quality improvement, America's Health Insurance Plans (AHIP) surveyed a representative model of commercial and Medicare Advantage member health insurance plans on behalf of more than 95,000,000 covered lives. The survey data, collected in 2009, demonstrate health plan activities and programs that improve quality of care, patient safety, and reduce costs to the health care system.
Health insurance plans are rewarding physicians and hospitals for quality of care provided to ensure patients receive the best care for their individual needs. By measuring and reporting on a standard set of confirmation-based metrics, health plans, physicians, and hospitals are working together to improve the quality of health care and promote accountability.
The new strategies followed by health insurance plan that help physicians and hospitals to improve patient health are,
Pay for Performance Programs: Health plans reward providers for achieving national benchmarks, demonstrating outstanding performance, and making measurable improvements over time.
Centers of Excellence: Health plans review nationally reported data and results from their own analysis to develop networks of facilities with strong track records of quality care, health outcomes, and patient satisfaction.
Targeted Quality Improvement Programs for Physicians and Hospitals: These programs focus on high-value opportunities such as prevention of hospital acquired infections, the patient centered medical home, and disease management, to name a few.
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